ACW Lee, YL Lau, SY Ha, KY Yuen, GCF Chan, RHS Liang, TK Chan, CY Yeung

Abstract

Infections remain one of the major complications of bone marrow transplantation (BMT). Among the first 23 allogeneic paediatric BMT carried out in Queen Mary Hospital from September 1991 to January 1995, there were 68 episodes of infectious complications. These included 19 (28%) pyrexia of unknown origin, 11(16%) clinically documented infections, and 38(56%) microbiologically documented infections. The pathogens identified were of bacterial (n=22, 58%), mycobacterial (n=2, 5%), fungal (n=4, 10%), viral (n=9, 24%) and protozoal (n=1, 3%) in origin, including 21 episodes of bacteraemia. Five children died after BMT of which 4 were directly related to infections (sinopulmonary aspergillosis 2, cytomegalovirus pneumonitis 1, microsporiosis 1). Thus infectious complication is a major cause of morbidity and mortality in children receiving BMT. Thorough investigation for the focus and cause of infections is a pre-requisite for successful management.

感染為骨髓移植中的主要併發症之一。瑪麗醫院從1991年9月至1995年1月進行的23例同種異體兒科骨髓移植中，發生感染併發症68次，其中不明原因發熱19次（佔28%），臨床診斷感染11次（佔16%），病原學診斷38次（佔56%）。病原分析：22次（佔58%）為細菌性感染，2次（佔5%）為分枝杆菌屬感染，4次（佔10%）為真菌性感染，9次（佔24%）為病毒性感染，1次（佔3%）為原虫性感染。21次菌血病。5例死亡病例中，4例由感染直接引起（2例為竇肺曲霉病，1例巨細胞病毒性肺炎，1例為小孢子菌病）。提示感染性併發症為引起兒科骨髓移植兒發病和死亡的主要原因，詳盡調查和研究感染及引起感染的原因為成功醫護骨髓移植病人的先決條件。